Postoperative Handover

Nagpal, Kamal; Arora, Sonal; Abboudi, May; Vats, Amit; Wong, Helen; Manchanda, Chhavi; Vincent, Charles; Moorthy, Krishna

doi:10.1097/sla.0b013e3181dc3656

Cited by 127 publications

(36 citation statements)

References 20 publications

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“…However, the OR to ICU handoff can be challenging, as it requires coordination of the physical transfer of the patient and of the knowledge transfer between multiple clinicians from anesthesia, surgery and critical care, typically performing in a busy clinical environment. 4 The handoff involves multiple steps (e.g., physical preparation of patient to leave the OR, transport to ICU), many systems (e.g., OR, ICU, laboratory, pharmacy, blood bank), and processes (e.g., transfer of electronic health record, assembling the clinical teams for the handoff). 5 While several studies have demonstrated the effect of the quality of a handoff on process metrics (e.g., information transfer, handoff duration, checklist compliance), little evidence exists to demonstrate the effect of the quality of a handoff on clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Operating room to intensive care unit handoffs and the risks of patient harm

McElroy

Collins

Koller

et al. 2015

Surgery

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Background The goal of this study was to assess systems and processes involved in the operating room (OR) to intensive care unit (ICU) handoff in an attempt to understand the criticality of specific steps of the handoff. Methods We performed a failure modes, effects and criticality analysis (FMECA) of the OR to ICU handoff of deceased donor liver transplant recipients using in-person observations and descriptions of the handoff process from a multidisciplinary group of clinicians. For each step in the process, failures were identified along with frequency of occurrence, causes, potential effects and safeguards. A risk priority number (RPN) was calculated for each failure (Frequency x Potential effect x Safeguard; range 1-least risk to 1000-most risk). Results The FMECA identified 37 individual steps in the OR to ICU handoff process. In total, 81 process failures were identified, 22 of which were determined to be critical and 36 of which relied on weak safeguards such as informal human verification. Process failures with the highest risk of harm were lack of preliminary OR to ICU communication (RPN 504), team member absence during handoff communication (RPN 480) and transport equipment malfunction (RPN 448). Conclusions Based on the analysis, recommendations were made to reduce potential for patient harm during OR to ICU handoffs. These included automated transfer of OR data to ICU clinicians, enhanced ICU team member notification processes and revision of the postoperative order sets. The FMECA revealed steps in the OR to ICU handoff that are high risk for patient harm and are currently being targeted for process improvement.

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Section: Introductionmentioning

confidence: 99%

Operating room to intensive care unit handoffs and the risks of patient harm

McElroy

Collins

Koller

et al. 2015

Surgery

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“…Issues including turnover of health care team members and shift work are risks inherent to the health care setting. 29,32 Ensuring high-quality information is consistently provided during handoffs not only helps mitigate threats to safety but also minimizes rework by nurses left with inaccurate or inadequate patient information. 29 Unfortunately, gaps in communication continue to have serious consequences.…”

Section: Comprehensive Unit-based Safety Program: Sparking the Interementioning

confidence: 99%

“…29,32 Ensuring high-quality information is consistently provided during handoffs not only helps mitigate threats to safety but also minimizes rework by nurses left with inaccurate or inadequate patient information. 29 Unfortunately, gaps in communication continue to have serious consequences. The Joint Commission collects and periodically publishes data on root causes of significant errors.…”

Section: Comprehensive Unit-based Safety Program: Sparking the Interementioning

confidence: 99%

“…The main purpose for all patient handovers is to accurately transfer information about each patient's situation and care plan, thereby ensuring patient safety and continuity of care. 29 Experts have promoted the value of standardized handover processes in high-stakes situations. Some lessons have come from other industries in which teams effectively use standardized processes to promote safety.…”

Section: Comprehensive Unit-based Safety Program: Sparking the Interementioning

confidence: 99%

“…Handover failures are a large source of medical error; therefore, opportunities for improvement must be identified and rectified. 29 Cardiac surgery patients may be particularly vulnerable because of the risk of hemodynamic instability during the transition from the operating room (OR) to the ICU. 30 These patients are highly complex and defenseless, as they are most often sedated, thus, communication errors may have serious and potentially grave consequences.…”

Section: Comprehensive Unit-based Safety Program: Sparking the Interementioning

confidence: 99%

See 2 more Smart Citations

Application of a Comprehensive Unit-Based Safety Program in Critical Care

Smith

Flanders

2014

Critical Care Nursing Clinics of North America

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Expansion of the Veterans Health Administration Network and Surgical Outcomes

et al. 2022

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ImportanceThe US Department of Veterans Affairs (VA) Veterans Choice Program (VCP) expanded health care access to community settings outside the VA for eligible patients. Little is known about the effect of VCP on access to surgery and postoperative outcomes. Since its initiation, care coordination issues, which are often associated with adverse postoperative outcomes, have been reported. Research findings on the association of VCP and postoperative outcomes are limited to only a few select procedures and have been mixed, potentially due to bias from unmeasured confounding.ObjectiveTo investigate the association of the VCP with access to surgery and postoperative outcomes using a nonrandomized controlled regression discontinuity design (RDD) to reduce the impact of unmeasured confounders.Design, Setting, and ParticipantsThis was a nonrandomized RDD study of the Veterans Health Administration (VHA). Participants included veterans enrolled in the VHA who required surgery between October 1, 2014, and June 1, 2019.InterventionsThe VCP, which expanded access to VA-paid community care for eligible veterans living 40 miles or more from their closest VA hospital.Main Outcomes and MeasuresPostoperative emergency department visits, inpatient readmissions, and mortality at 30 and 90 days.ResultsA total of 615 473 unique surgical procedures among 498 427 patients (mean [SD] age, 63.0 [12.9] years; 450 366 male [90.4%]) were identified. Overall, 94 783 procedures (15.4%) were paid by the VHA, and the proportion of VHA-paid procedures varied by procedure type. Patients who underwent VA-paid procedures were more likely to be women (9209 [12.7%] vs men, 38 771 [9.1%]), White race (VA paid, 54 544 [74.4%] vs VA provided, 310 077 [73.0%]), and younger than 65 years (VA paid, 36 054 [49.1%] vs 229 411 [46.0%] VA provided), with a significantly lower comorbidity burden (mean [SD], 1.8 [2.2] vs 2.6 [2.7]). The nonrandomized RDD revealed that VCP was associated with a slight increase of 0.03 in the proportion of VA-paid surgical procedures among eligible veterans (95% CI, 0.01-0.05; P = .01). However, there was no difference in postoperative mortality, readmissions, or emergency department visits.Conclusions and RelevanceExpanded access to health care in the VHA was associated with a shift in the performance of surgical procedures in the private sector but had no measurable association with surgical outcomes. These findings may assuage concerns of worsened patient outcomes resulting from care coordination issues when care is expanded outside of a single health care system, although it remains unclear whether these additional procedures were appropriate or improved patient outcomes.

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Postoperative Handover

Cited by 127 publications

References 20 publications

Operating room to intensive care unit handoffs and the risks of patient harm

Operating room to intensive care unit handoffs and the risks of patient harm

Application of a Comprehensive Unit-Based Safety Program in Critical Care

Expansion of the Veterans Health Administration Network and Surgical Outcomes

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